Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Baby Planning

There is a website from a center in Norway that deals with the management of pregnancy for mothers with rheumatic diseases, known as "Center for Mothers with Rheumatic Disease" - to my understanding, this center was founded by one of the world’s leading experts in management of rheumatic pregnancies including AS, Dr. M Ostensen. The website offers information, and the center offers the opportunity for you or your health care provider to write in and ask for advice: "If you are a woman with rheumatic disease planning a pregnancy or caring for small children, you can contact the Center for information and counseling. Health professionals caring for rheumatic mothers, are also welcome to contact the Center."
http:// http://www.revma.org/default2.htm

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9458214&dopt=Abstract
Ostensen M, Ostensen H.
Ankylosing spondylitis--the female aspect.
J Rheumatol. 1998 Jan;25(1):120-4.
PMID: 9458214
"OBJECTIVE: To study reproductive performance and interaction between ankylosing spondylitis (AS) and pregnancy in a large population of female patients. METHODS: In collaboration with the Ankylosing Spondylitis International Federation, a questionnaire including clinical data and details on past and recent pregnancies was sent to the female members of national and regional AS societies in the USA, Canada, and 11 European countries. RESULTS: Nine hundred thirty-nine questionnaires were completed, showing the following clinical data. Mean age at onset of AS was 23 years. The onset was related to a pregnancy in 21%. The frequency of accompanying features of AS was as follows: peripheral arthritis 45%, acute anterior uveitis 48%, psoriasis 18%, and inflammatory bowel disease 16%. Six hundred forty-nine women with previous pregnancies had on average 2.4 pregnancies per woman, of which 1.4 pregnancies were during disease. Of pregnancies 15.1% ended with miscarriage. Disease activity during 616 previous and 366 recent pregnancies was unchanged in 33.2%, improved in 30.9%, and worsened in 32.5%. Improvement of disease activity during pregnancy was correlated with a history of peripheral arthritis. It was also observed more often among those having a female than a male child (p = 0.02). A postpartum flare within 6 months after delivery was experienced by 60%, most often patients with active disease at conception. Delivery occurred at term in 93.2% of cases. The rate of cesarean section was high and due to AS in 58% of cases. The majority of neonates were healthy and had a mean birthweight of 3339 g. AS had an adverse effect on being a mother and a caregiver. CONCLUSION: AS did not adversely affect fertility, pregnancy outcome, or the neonate. Improvement during pregnancy was related to a history of peripheral arthritis and a female fetus. Active disease at conception was a predictor of a postpartum flare."

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9928503&dopt=Abstract
Gran JT, Ostensen M.
Spondyloarthritides in females.
Baillieres Clin Rheumatol. 1998 Nov;12(4):695-715. Review.
PMID: 9928503
"…Although fetal outcome is not compromised in women with spondyloarthropathy (SpA), the interaction of pregnancy and SpA has been studied in detail only in AS. Spinal disease is unchanged while peripheral arthritis and uveitis are suppressed during childbearing…"

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1285888&dopt=Abstract
Ostensen M.
The effect of pregnancy on ankylosing spondylitis, psoriatic arthritis, and juvenile rheumatoid arthritis.
Am J Reprod Immunol. 1992 Oct-Dec;28(3-4):235-7.
PMID: 1285888
"Patients with PsA improved or even remitted in 80% of the pregnancies, whereas 80% of the AS patients had unaltered or aggravated disease symptoms. The 20% of AS patients who markedly improved while pregnant all had AS with accompanying diseases like psoriasis, ulcerative arthritis, or small joint arthritis…. Fetal outcome was not adversely affected by AS, PsA, or JRA nor did there occur serious intercurrent diseases during pregnancy. In AS and PsA patients delivery was mainly uncomplicated."


The following is from the FAQ on the Center for Mothers with Rheumatic Disease website, mostly the same info as above, just different about uveitis:
" The effect of pregnancy on ankylosing spondylitis:
The interaction of pregnancy and ankylosing spondylitis (AS) has been extensively studied. In about 60% of pregnancies, disease activity of AS is either changed [I THINK THEY MUST MEAN "UNCHANGED" HERE, MUST BE A TYPO] or aggravated. In patients with active AS, an aggravation of symptoms occurs most often during the first half of gestation. Improvement of symptomes occurs inabout 1/3 of pregnancies, most often in women who also have arthritis in large or small joints. Pregnancy does not prevent the occurrence of anterior uveitis. AS is not a hinder for having a normal delivery. AS does not adversely effect fertility, pregnancy outcome or the neonate. A flare of disease within 6 months after delivery is experienced by about 60% of the patients."
From:
http://www.revma.org/default2.htm

http://www.bidmc.harvard.edu/obgyn/preg_nut_carbo.asp
"Do Not Restrict Carbohydrates During Pregnancy
Restricting carbohydrates can be very dangerous, especially during pregnancy. Fortunately, low-carbohydrate diets have gone out of fashion. When your body breaks down carbohydrates, glucose (sugar) is released. Your baby needs glucose to develop a health nervous system. If you do not take in enough carbohydrates, your body will, instead, begin to break down its fat reserves to nourish your baby. When fats are broken down, ketones (not glucose) are released. There is some evidence that these ketones may be harmful to the baby's developing nervous system. This is why pregnant women should not skip meals, as they will start to form ketones very quickly"

http://www.centerforwomenshealth.com/pregnancy.htm
"Complex Carbohydrates:
A pregnant woman's calories should come from all three energy sources: proteins, fats, and complex carbohydrates. If you restrict your carbohydrate intake during pregnancy you can put the fetus at risk. Without carbohydrates your body will burn proteins and fat for fuel. Two things happen physiologically with this: 1. There may not be enough protein available for the developing brain and nervous system of your baby, and 2. Burning fats can release ketones (an acid by product of fat metabolism) that can be destructive to fetal brain cells and the delicate acid-base balance of the fetal system. Low carbohydrate diets can be dangerous in pregnancy."

Edited by Evelyn on 04/04/02 01:33 PM (server time).

Edited by Evelyn on 04/04/02 01:34 PM (server time).

Hi Natalie,

Baby planning is not my area (at all) BUT even though I am a big fan of the No Starch Diet (NSD) I don't know if its worth doing while pregnant. Having said that it may be OK to reduce the amount of starchy foods like bread, potato, pasta and increase fruits. The previous posts here talked about the damage that a low carbohydrate diet can do to the baby but the NSD isn't a low carb diet - its getting carbs in a simplified form. But I still agree that it may be too risky although as I said just reducing a bit on the starch and upping the fruit may be OK. I would consult a nutrionalist that specialises in pregnancy and raise these issues with them.

As for the pain and having no NSAIDS - I would try Fish Oil capsules (Deep sea may be best). There is a lot of evidence that fish oil reduces inflammation due to its Omega 3 properties. You can get this at most chemists or even supermarkets. Look, check with your doctor but I'm sure this may be a great alternative. I take them and although not as effective as Indocid it may be a good and safe alternative.

Oh, by the way I've sent you a Private Message (PM) re. our AS Group in Australia if you want to take a look.

Don't think you can - KNOW YOU CAN

I completly agree,

When it comes to diet durring pregnancy, I wouldn't mess around. If you do intend on trying out LSD or NSD, I would strongly recommend seeking out a knowlegable dietician. You don't want to place your baby's health on the experiences of a handfull of people, you need to go to someone who knows about this, and can help you along the way. Good luck.

Take care my friend

Daniel

Keep on keepin on Kicking some AS

Hi and welcome. I just had my second baby in December. My suggestion is to get a TENS machine and use it on all your pains. Tylenol can also be taken even in the first few weeks of pregnancy. Take baths when the pain is intolerable. I have to say that I took baths twice a day when I was pregnant (still do because of pain). E-mail me and I can give tons of support.
De Ann

Thankyou to everyone for your advice and support.

I will keep you posted on how it all goes.

Natalie

Cindy, You know when I was pregnant my AS was not so bad. In fact I barely had any symtoms. Maybe its all that extra estrogen floating around. I did notice that with my last baby my back hurt more, but I was 33 by then no spring chicken. I did work as a bar tender till my last trimester though. After Abigail was born I went into the worst flare but then luckily or not I didn't know what was wrong with me and the Dr I saw told me it was all in my head. " Baby Blues" was the term. Hope I didn't scare you Natilie. Pregnancy was one my most favorite times in my life. Good luck. Rose

Its quite common for many AS'ers to have reduced AS symptoms when either pregnant or even have the flu.

It was explained to me once that the theory is when your immune system has something else to concentrate on as well as your AS like in fighting the flu then it lessens the response to your joints. I guess being pregnant the immune sytem is looking after the baby or something and thats why after you give birth the AS can come back strong as ever like a flare.

Answer - gee what would be more exhausting - having AS or being pregnant all the time. Or else maybe go and seek out those with the flu to pass it on to you.

Don't think you can - KNOW YOU CAN

Makes sense about the immune system having something else to work on. I don't konw what would be better pregnant or flu, I think with the flu you would have a better figure?! You would be sick most of the time either way. I wonder if the Pill could help with AS does't it make your body think it is Pregnant ? Maybe I am wrong but I thought it fooled your body for the 28 days. Have no idea I was in urology when I worked Whole other end of the spectrum. Rose